This document discusses different treatment options for brain aneurysms, focusing on endovascular coiling. It describes what a brain aneurysm is, explains different treatment options including surgical clipping and endovascular coiling, and provides details on techniques for coiling such as balloon-assisted coiling and stent-assisted coiling. It also summarizes results from clinical trials comparing coiling to clipping, finding lower rates of death and dependency with endovascular coiling for both ruptured and unruptured aneurysms.

1. Brain Aneurysm Coiling
(Endovascular treatment of brain Aneurysms)
Dr. Avinash KM
MS, MRCS Ed(UK), Mch (KEM, Mumbai), FINR(Switzerland), FMINS(Germany),
• Interventional & Neurovascular surgeon and Stroke specialist,
• Endoscopic Neuro and Spine surgeon,
• Minimally invasive Neuro and Spine surgeon (FMINS).
mob: 9740866228, E mail: doc_avin@hotmail.com
Consultant Neurosurgeon and Neurointerventionist
Columbia Asia Hospital, Bangalore.

2. What is brain Aneurysm?
A brain aneurysm, also referred to as a cerebral aneurysm or intracranial
aneurysm (IA), is a weak bulging spot on the wall of a brain artery very much
like a thin balloon or weak spot on an inner tube. Over time, the blood flow
within the artery pounds against the thinned portion of the wall and
aneurysms form silently from wear and tear on the arteries. As the artery wall
becomes gradually thinner from the dilation, the blood flow causes the
weakened wall to swell outward. This pressure may cause the aneurysm to
rupture and allow blood to escape into the space around the brain. A
ruptured brain aneurysm commonly requires advanced surgical treatment

3. Treatment options for Brain Aneurysms:
• Surgical clipping :
• Endovascular coiling
• Parent artery sacrifice with or with out bypass surgery.
• Conservative management (no treatment)
Endovascular treatment for Brain aneurysms:
• Coiling of aneurysm:
• Stent assisted coiling:
• Balloon assisted coiling:
• Flow diverters:

4. Coiling of aneurysm:
Endovascular (meaning within the blood vessel)
embolization, or coiling, uses the natural
access to the brain through the
bloodstream via arteries to diagnosis and
treat brain aneurysms. The goal of the
treatment is to safely seal off the aneurysm
and stop further blood from entering into
the aneurysm and increasing the risk of
rupture or possibly rebleeding.
Following diagrams show how aneurysm coiling is done
Coil mass inside aneurysm
prevents blood from
entering it

5. Watch videos to know more about coiling:
Following videos demonstrate the procedure of
aneurysmal coiling.
http://www.youtube.com/watch?v=-dYC1gyqomM
http://www.youtube.com/watch?v=eLIPCvT49yI
http://www.youtube.com/watch?v=5Ss-IOmFyeA

6. Balloon assisted coiling:
In slightly wide necked aneurysms balloon assistance is taken to coil an
aneurysm in order to prevent prolapse of coil mass into the artery.

7. Stent assisted coiling:
For wide necked aneurysms stent can be placed to hold coil mass
inside the aneurysm.

8. Other techniques of stent assisted
coiling in wide necked aneurysms
Using double stents in Y
shape to coil complex wide
necked aneurysms
Watch following video for better understanding of
technique
http://www.youtube.com/watch?v=MfdPbBZ6ETs&feature=related

9. Flow diverter:
Flow diverter is a kind of stent which can be used with out
use of coils.
Watch following video for better understanding
http://www.youtube.com/watch?v=jd5VQTS096E&feature=related

10. Which one of the two modalities is better?
Coiling or Clipping?
Morbidity and Mortality:
ISAT TRIAL (for ruptured aneurysms): Dead or dependent at one year-
• Surgical group: 30.6% patients were dead or dependent at one year
• Endovascular group: 23.7% of patients were dead or dependent at one year
ISUIA trial (for unruptured aneurysms) Death and dependency at 1
year:
• Surgical group: The 1-year morbidity and mortality rate
was 12.2%, and the mortality rate was 2.3%.
• Endovascular treatment: The 1-year total morbidity
and mortality rates were 9.5% and 3.1%, respectively.